Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 4814 | CT |
NPI | 1003474115 |
---|---|
Provider Name | Leanne Des Rosiers |
First Address | Hartford, CT 06107-2184 |
Second Address | Hartford, CT 06107-2162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2019 |
Last Update Date | 24/03/2021 |